Advanced backward planning with custom-milled individual allogeneic block augmentation for maxillary full-arch osteoplasty and dental implantation:a 3-year follow-up

Manfred Nilius,Minou Helene Nilius,Bernhard Weiland,Guenter Lauer,Charlotte Mueller,Dominik Haim

doi:10.1007/s10561-021-09947-3

Manfred Nilius, Minou Helene Nilius + Show 4 more

Open Access

https://doi.org/10.1007/s10561-021-09947-3

Copy DOI

Abstract

In the case of maxillary involution, augmentation is necessary for implant-supported prosthetics. The use of bone grafts is standard; customized allogeneic bone blocks may be a predictable alternative before dental implantation. For maxillary full-arch reconstruction, this case shows a horse-shoe augmentation by four allogeneic blocks, followed by guided dental implantation and fixed prosthetics after 6 months of healing. Using allogeneic blocks is an option for full-arch maxillary augmentation and comparable with autologous bone grafts. There is no donor site comorbidity. Bone height is stable for a minimum of 3 years after loading with resorption less than 10% in vertical, buccolingual, and mesiodistal directions. Short-implants allow for the long-term stability of prosthetic fixtures. Prefabricated customized allogeneic blocks for augmentation may increase the fitting accuracy of the graft, decrease morbidity, and lower operation time in maxillary full-arch reconstruction. The percentage of resorption after 3 years is comparable to the commonly used iliac crest.

Highlights

No adequate amount of bone in the maxilla or a retromaxillary involution indicates bone block grafting or sinus lifting before implantation
In this article, customized allogeneic bone blocks are prepared for onlay-augmentation to improve bone height and bone quantity before dental implantation
We examined 30 patients (24–77 years; mean: 49.7; m: 11, f: 19) 3 years to compare the resorption and the long-term volume stability of allogeneic blocks with other augmentation methods

Summary

Introduction

No adequate amount of bone in the maxilla or a retromaxillary involution indicates bone block grafting or sinus lifting before implantation. Autologous transplants as gold standard bear comparable high stress for the patient (Cricchio and Lundgren 2003). In these cases, allogenic bone blocks can be a suitable alternative. After osseous integration of the blocks, advanced backward planned dental implants were the method of choice for a stable, secure fixing of prosthetic restoration. A 72-year old patient with a small amount of residual bone height (vertical height B 3 mm) in the edentulous maxilla consulted the clinic for an implant treatment The high-grade alveolar ridge atrophy, the low palatal arch, and the edentulous upper jaw’s retro position did not allow implantation into the local bone. The patient rejected zygoma-implants because palatal placed prosthetic abutments could narrow the tongue’s space; Le-Fort1-Osteotomy or maxillary advancement with iliac crest declined because of operative load and possible

Methods

Results

Discussion

Conclusion